Provider Demographics
NPI:1881228724
Name:OLIVER, DANIELLE (PTA, LMT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:PTA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 W I 240 SERVICE RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-4400
Mailing Address - Country:US
Mailing Address - Phone:405-570-2672
Mailing Address - Fax:405-724-9617
Practice Address - Street 1:508 W I 240 SERVICE RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-4400
Practice Address - Country:US
Practice Address - Phone:405-570-2672
Practice Address - Fax:405-724-9617
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-01
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK585715225700000X
OK3146225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK585715OtherMEDICAL MASSAGE THERAPIST
OK200968080AMedicaid
OK3146OtherPHYSICAL THERAPY